Is It Time to Move Towards Human Papilloma Virus (HPV) Testing in Self-Collected Genito-Urinary Samples for Cervical Cancer Screening? A Survey-Based Study from India

*Meenal Agarwal
Department Of Genetics, GenePath Diagnostics India Private Limited, Pune, Maharashtra, India

*Corresponding Author:
Meenal Agarwal
Department Of Genetics, GenePath Diagnostics India Private Limited, Pune, Maharashtra, India

Published on: 2021-08-14


Background: Cervical cancer is one of the most common as well as the most preventable cancer. Screening tests have been developed for decades, but awareness, availability and uptake have not been uniform especially in low-resource countries.

Aim: Gauging the knowledge, awareness and attitude of women towards cervical cancer, willingness to undergo screening and preferred sample collection methods.

Method: Women in an urban region of India were given an online survey regarding cervical cancer, screening and preferred type of sample collection.

Result: 836 women participated in this study, 87.2% were already aware about cervical cancer, 65.7% were aware of screening, 60.4% preferred self-collection of genito-urinary samples for screening.

Conclusion: Despite being aware of cervical cancer and screening protocols, the screening rate was extremely low. Majority of women preferred self-collection of samples for screening. This information can be used to strategize accessible and acceptable screening programs, beginning with promotion of self-collection of genito-urinary samples for HPV DNA testing.


Cervical Cancer, Screening, Human Papilloma Virus (HPV), Self-Collection, Genito-Urinary Samples


Cervical cancer is the fourth most common and fatal cancer among women globally [1]. Almost all cases of cervical cancer are caused due to long term persistence of one/more high-risk human papillomavirus (HPV) strains in the cervical epithelial cells. Since cervical cancer develops over a long span of time, various screening tests have been developed and are aimed at identifying presence of high-risk HPV strains and/or precancerous lesions at early actionable stages [2] (Table 1).

Various cervical cancer screening guidelines exist from different organizations, [World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), American Cancer Society, Australian Department of Health, Indian Society of Colposcopy and Cervical Pathology (ISCCP) and Federation of Obstetrics and Gynecology Society of India (FOGSI)] which overlap or differ over the age of initiation of cancer screening (21 Vs 25 Vs 30 years) and employment of HPV test alone Vs Co-testing by HPV and cytological tests. Despite the development of these screening guidelines, about 604,000 women were diagnosed with and about 342,000 women succumbed to cervical cancer globally in 2020 [1]. In India the overall population coverage for cervical cancer screening is estimated to be only about 10-20% [9]. Currently certain opportunistic cancer screening programs and guidelines have been formulated in India too, but organised nation-wide implementation needs to be addressed to reach majority of the population and for maximum uptake [10]. To gain a better understanding of where the gap lies, we undertook an online survey for women in Pune city in India. The aim of this survey was to try and assess the knowledge, attitude and awareness about cervical cancer, different screening modalities, their uptake and preference of sample collection methodology.

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